Saudi Arabia has made significant advancements in providing accessible and quality healthcare. The Ministry of Health (MOH), through the Saudi Center for Disease Control and Prevention (CDC) ‘Weqayah’, has developed national guidelines (12) for PHEs for multiple age groups, including adolescents, as PHEs play an essential role in preventive measures. Although MOH and CDC provide efforts to apply PHEs, local studies revealed that awareness and utilization of PHEs vary across demographics and regions.(16,22–24,28,29,36,37,40) This study aimed to assess the awareness, knowledge, and performance of PHEs among adolescents in Riyadh.
According to the findings of this study, the vast majority (70.6%) of adolescents were aware of the existence of PHEs for their age group. This high level of individual awareness was directly in alignment with many previous studies (13–15,17–21,25) and could be credited to the efforts of MOH, Saudi CDC, and private healthcare providers through the implementation of multiple health education campaigns and programs such as; “Know your numbers” campaign, School-based obesity control (Rashaqa) campaign, the national guideline for PHEs and others. (12,47) Digital sources, such as; the internet and television, were the most common sources for the adolescents' information, which was consistent with multiple previous studies (16,19,22), compared to a study in China, where the most useful resource along with digital media was Medical staff. (26)
Adolescents exhibited lower levels of knowledge towards the details of PHEs, (43.9%). A similar study in Jazan, Saudi Arabia, revealed that only (40%) had an adequate level of knowledge about PHEs.(24) Also, a study in Northwest Nigeria concluded that only (43%) of the participants demonstrated sufficient knowledge of PHEs.(19) On the other hand, most studies showed higher levels of PHEs related knowledge(14,16,22,27–34). For example, a local study conducted in Makkah region concluded that (76.4%) of the participants had an adequate level of knowledge.(23) Despite the higher levels of awareness and multiple attempts to improve the perceptions among the population, the levels of knowledge weren't adequate. This could be attributed to the limitations in the adequacy and comprehensibility of health information, as highlighted by specific findings in the Health Literacy Assessments done by local studies.(48) A well-structured health education program for adolescents should be planned and considered age-appropriate information for their age group.
There were clear associations between socio-demographic characteristics of adolescents, like gender, nationality, and educational level with knowledge and performance of PHEs. In terms of gender with knowledge, females had better knowledge than males. This finding was in alignment with a study in Makkah region where females were significantly more knowledgeable than males (23), and also in Pakistan, where two studies showed that females had better results than males, (20,33) and in some other studies.(29,31,36) While in Jazan, Riyadh, and Al Jouf, males were more knowledgeable than females.(16,22,24) However, some studies reported no association between gender and the level of knowledge. In Uganda for example, gender had no significance in determining the knowledge adequacy of participants. (15) In addition, the association between gender and performance in the literature fluctuates, where some studies confirmed the association (21,22,28,31,32,36,40,42,49) and others didn't. (13–15,18,20,24,26,27,33,39,43) Overall, most literature clearly indicates female dominance in the sense of knowledge and performance of PHEs. This observation could be attributed to the fact that females are more invested in their health-seeking behavior because they confront the implication of any symptom they experience, while males, conversely, tend to ignore their health to be seen as strong and masculine.(50,51)
Individuals with high education often exhibit better health-seeking behavior. This may originate from the suggestion that the increased health literacy, can enable them to have a better understanding of symptoms, treatment options, and preventive measures, which can protect them from misinformation, missed diagnoses, delayed care, and potentially worsening health outcomes.(52) In that regard, this study reported a direct association between the educational level of adolescents or their parents with both the levels of knowledge and performance of PHEs, which was consistent with most of the study literature, (13–19,21–24,29,31,33,36,38,40) while some wasn’t. (20,26,27,39,43) This emphasizes the positive role of literacy on individuals’ knowledge of their well-being.
As expected, there was a positive association between the presence of health insurance and the level of knowledge. It also found that its motivated adolescents towards the performance of PHEs. Which was in alignment with other previous studies. (21,34,36,37,40,53) however, some studies observed no significance. (17,26) The positive impact was attributed to the ease of use, the time-saving, the access to a broader range of healthcare services, and incentive plans such as; discounts on gym memberships and healthy lifestyle products. However, those with no health insurance were eligible to seek healthcare without any cost as the Kingdom of Saudi Arabia provides healthcare for free in all public facilities to all citizens. These high levels of opportunities did not match the levels of health accessibility. Studies suggested that direct factors such as; limited staffing, higher workload, crowded healthcare centers, shortage of required infrastructure, and lower expertise were obstructing public healthcare.(17,22,24,49)
The identification of the meaning of PHEs among adolescents in this study stands in the middle of international figures, where a study claims that adolescents have good insight about the definition of PHEs (17) and another study shows the opposite (19). The STDs, as one of the recommended PHEs for adolescents, were the least identified assessment by our participants. This was inconsistent with a study in Africa where adolescents and adults thought that STDs should be part of PHEs for adolescents, (54) and this definitely reflects cultural differences.
The overall attitude of adolescents towards the perception and practicing of PHEs seemed to be positive, and that could be observed from their willingness to perform PHEs and the tendency to recommend them to others which also led them to perform both recommended and non-recommended PHEs.
As anticipated, almost half of adolescents engaged in some sort of PHEs, and (26%) of them did it regularly. The majority of the study literature had come to the same conclusion, that populations have a low level of practice of PHEs.(13,15–19,21–24,27,28,31,34,36–38,40–43) On the other hand, some studies presented surprisingly promising results. (14,20,25,26,30,32,33,35,39) The justification for this phenomenon according to adolescents was; Inadequate knowledge, their financial status and unavailability of health insurance, fear and worrying, being healthy, lack of desire and enthusiasm, lack of family support, and lack of transportation, which were also observed in some other studies. (14–17,19–22,26,27,29,30,32–34,36,38–41,49,54)
Despite the widespread awareness and knowledge about the PHEs, studies revealed a notable disconnection between knowing and doing. While many communities demonstrated high levels of PHE awareness and knowledge, the actual participation often falls short.(13–19,21,23,27,36) However, the opposite was reported in this study and also in other studies (14,20,25,30,32,33) and was justified by the assumption that societies with more knowledgeable populations had better exposure and experience with PHEs. (27) This contradiction emphasizes the complicated nature of the relationship between knowledge and practice, which was influenced by a range of factors beyond knowledge spreading. Studies exploring this relationship demonstrated the influence of factors such as; financial status, availability of resources, accessibility, psychological issues, and others on the practice (14–17,19–22,26,27,32–34,36,38–41,49,54) which were compatible with what was indicated by adolescents as obstacles hindering them from performing PHEs in this study.